Healthcare Provider Details

I. General information

NPI: 1477809325
Provider Name (Legal Business Name): COLUMBIA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS STE D107
CATSKILL NY
12414-1205
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1442
  • Fax: 518-697-5348
Mailing address:
  • Phone: 518-828-8334
  • Fax: 518-828-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1001000H
License Number StateNY

VIII. Authorized Official

Name: BRYAN T MAHONEY
Title or Position: CFO
Credential:
Phone: 518-828-8090